Late Breaking Original Research
Sunday, October 13, 2024
12:45 PM–02:15 PM
Abstract
Introduction: Prompt, appropriate antibiotic therapy is critical in treating bacterial sepsis. Identification of the organism from a blood culture takes days, but this process can be expedited with polymerase chain reaction (PCR) assays, which detect bacterial DNA and their resistance genes within twenty-four hours of drawing blood. Part of clinical pharmacists’ workflow is to interpret sepsis PCR results and make recommendations to the patients’ medical team on how to escalate or deescalate antibiotic therapy based on the identified organism. The pharmacist-initiated change in therapy was evaluated to determine its effect on outcomes in sepsis.
Research Question or Hypothesis: To determine how pharmacists’ sepsis PCR interventions affect length of stay (total and ICU), ICU admissions, and in-hospital mortality.
Study Design: Institutional Review Board-approved, multicenter, retrospective chart review.
Methods: Adult patients with sepsis who had a positive PCR test intervened on by a pharmacist between October 1, 2016 and September 30, 2023 were identified for randomized inclusion. Data was collected by reviewing electronic medical records.
Results: Patients with antibiotic therapy changes from pharmacist PCR interventions had a significantly shorter hospital stay (median 7 vs. 9 days, p = 0.0228). ICU admissions were lower with escalation compared to no change (38.2% vs. 56.2%, p = 0.0124), but no difference was observed with deescalation (60.0% vs. 56.2%, p = 0.7133). Changes in antibiotic therapy (escalation or deescalation) did not impact in-hospital mortality, ICU length of stay, or SAPS II score. Patients without therapy changes were younger (median 64 vs. 58 years, p = 0.0156). Higher SAPS II scores were associated with increased in-hospital mortality (median 30 vs. 28, p = 0.0619). Analyse-it Software Ltd was used for statistical analysis.
Conclusion: The act of escalating antibiotic therapy based on PCR results significantly reduced total length of hospital stay and ICU admissions. Patients who were younger were less likely to receive a change in therapy.
Presenting Author
Sarah Ayers PharmDWest Virginia University School of Pharmacy
Authors
Charles F. Seifert Pharm.D. FCCP. BCPS